Evolution of bone densitometry parameters and risk of fracture in coeliac disease: a 10-year perspective

Abstract

Background: Metabolic bone disease is frequently found in patients with coeliac disease (CD). Despite its high prevalence, international guidelines are partially discordant about its management due to the lack of long-term data.

Methods: We retrospectively evaluated a large dataset of prospectively collected data of CD patients assessing the variation of DXA parameters and estimated fracture risk according to the FRAX^® score in a 10-year follow-up. Incident fractures are reported, and the predictive ability of the FRAX^® score is verified.

Results: We identified 107 patients with low bone density (BMD) at the diagnosis of CD and a 10-year follow-up. After improving at the first follow-up, T-scores slowly reduced over time but with no clinically relevant differences between the first and last examination (lumbar spine: from - 2.07 to - 2.07, p = 1.000; femoral neck: from - 1.37 to - 1.55, p = 0.006). Patients with osteoporosis at the index measurement had more marked fluctuations than those with osteopenia; the latter group also showed minimal modifications of the FRAX^® score over time. Six incident major fragility fractures occurred, with a good predictive ability of the FRAX^® (AUC 0.826).

Conclusion: Adult CD patients with osteopenia and no risk factors had substantially stable DXA parameters and fracture risk during a 10-year follow-up. A dilated interval between follow-up DXA for these patients could be considered to reduce diagnosis-related time and costs, maintaining a 2-year interval for patients with osteoporosis or risk factors.

Keywords: Bone; Coeliac disease; Dual-energy X-ray absorptiometry; Fractures; Gluten; Gluten-free diet; Osteoporosis.

Fig. 1

Supplements and drugs prescribed at the first evaluation and during the follow-up

Fig. 2

Evolutive changes of dual-energy X-ray absorptiometry parameters in the study population (n = 107)

Fig. 3

Evolutive changes of dual-energy X-ray absorptiometry parameters stratified according to the presence of osteoporosis (n = 32) or osteopenia (n = 75) in at least one site at the index examination

Fig. 4

Image of individual variations in fracture risk according to the FRAX algorithm after 10 years from the start of the gluten-free diet. Percentage changes from the baseline score are reported, with patients being stratified as increased-risk group (i.e., patients with osteoporosis at the baseline dual X-ray absorptiometry or risk factors for fragility fracture—n = 43) or standard-risk group (n = 64)